Certificate issued under s 7.23(1) of the Motor Accident Injuries Act 2017

1. The panel revokes the certificate of Medical Assessor Farhan Shahzad dated

31 December 2024. 2. The panel finds that the claimant has sustained whole person impairment of 5% which is less than 10%, * cervical spine-soft tissue injury.

1. Azzam Elmir (the claimant) is a 62-year-old man who was injured in a motor vehicle accident on 25 October 2022. Following the accident the claimant lodged an application for Personal Injury Benefits and thereafter it was determined that the claimant had sustained non-threshold injuries.
2. The claimant sought a concession from the insurer that his injuries exceeded 10% whole person impairment. Following a review the insurer declined to make this concession and consequently the claimant lodged an application for assessment of whole person impairment.
3. The claimant was examined by Medical Assessor Farnham Shahzad on 11 December 2024 who, in a certificate dated 31 December 2024, determined that the injuries caused by the motor accident gave rise to a permanent impairment of 12%.
4. The insurer sought a review of this certificate and in a certificate dated 28 March 2025, President's delegate Melinda Drew certified that there is a reasonable cause to suspect the medical assessment was incorrect in a material respect. Accordingly, the matter was referred to this Medical Panel.
5. The Panel convened on 23 June 2025 and noted that the earlier direction issue to the parties have been complied with an all material which was before Medical Assessor Farnham Shahzad was now before the panel.

1. Section 57 of the Motor Accidents Compensation Act 1999 (MAC Act) defines a "medical dispute" as a disagreement or issue to which Part 3.4 of the MAC Act applies.
2. Sections 58 and 60 of the MAC Act together with cls 1.5-1.7 of the Guidelines set out the procedures for referral to one or more Medical Assessors and the principles to be applied at such assessments.
3. Clause 14F of Schedule 1 of the Personal Injury Commission Act 2020 (the PIC Act) provides that the new review provisions apply in relation to a decision of a new decision-maker. A "new decision maker" is defined in cl 14A(1) of the Schedule 1 of the PIC Act. As the medical assessment, the subject of the review, was made on or after 1 March 2021, the new review provisions apply.
4. The new review provision provide that a review panel consists of two Medical Assessors and a Member assigned by the Motor Accidents Division of the Commission.
5. Part 5 of the PIC Act enables the Commission to make rules with respect to its practice and procedure including proceedings before a panel reviewing a decision of a Medical Assessor.
6. Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC Rules) are made pursuant to Part 5 of the PIC Act. A review panel determines how it conducts and determines the proceedings and may determine the matter solely based on the written application.
7. The review of the medical assessment is by way of a new assessment of all the matters with which the medical assessment is concerned.
8. The claimant was examined by Medical Assessor David McGrath on 5 August 2025 at

the Commission's Medical Suites and an Arabic interpreter was present.

Pre-accident medical history and relevant personal details

1. Mr Elmir is 64 years of age. He has five children aged from 35 to 25. All his children have left home, and he lives with his wife.
2. Mr Elmir emigrated from Lebanon in 1991 at around age 28. In Lebanon, he started a degree in history, law and Arabic but did not complete these studies. He came to Australia and did several occupations including upholstery and kitchen carpentry before settling on structural formwork.
3. He was in a motor vehicle accident in around 2013 which coincided roughly with him becoming more part-time. He states that his physical injuries were not the restricting factor but rather the availability of work. Regardless of that point, he was not in full-time work at the time of his motor vehicle accident.
4. Mr Elmir records a previous sporting interest in soccer during his young adolescent years.
5. As stated above, Mr Elmir records a motor vehicle accident in 2013. His vehicle was hit on the right-hand side, and experienced right shoulder, right knee, right hip and lumbar spinal pains. He saw doctors and had physiotherapy and gradually returned to work.
6. He does not give a history of any falls or broken bones. He had surgery for his appendix. He does not record any medical conditions or psychiatric problems.

1. Mr Elmir was involved in a motor vehicle accident on 25 October 2022 at approximately 6.00am. He was going to his son's house to assist with some renovations. He was stationary at a traffic light when he was hit from the rear in a four car collision. That is, he was the third impact in the four car involvement. Mr Elmir states that he was jolted and shocked by the accident and stayed in the car for 10 minutes or so feeling dizzy. He managed to get out by himself and exchanged details with the other drivers and then drove home, a journey of 15 minutes. Police and ambulance were not in attendance at the scene of the accident.

History of symptoms and treatment following the motor accident

1. At home, he was aware of pain or discomfort about the left knee, left elbow and neck region.
2. Mr Elmir consulted his general practitioner (GP) within a couple of weeks. He states it was not easy to obtain a consultation. At the consultation on 7 November 2022, his GP, Dr Ali, recorded left knee and left elbow pains.
3. The lower back and left shoulder were not initially mentioned. Mr Elmir explained that his injuries were investigated in a sequence of logical steps leading from neck investigations through to other symptomatic regions.
4. Mr Elmir was treated with physiotherapy and hydrotherapy which gave short term relief. He has seen specialists for the spine, shoulder and knees, each focusing on a different aspect.
5. He ceased work and is now on a disability pension.

Details of any relevant injuries or conditions sustained since the motor accident

1. Mr Elmir was asked to sketch out his pains onto a body diagram. He indicated that he had neck pain which was located more on the left-hand side interfering with left shoulder girdle function. He also experienced pain about the left elbow which tended to correlate with the shoulder and neck pains. He also recorded left-sided lower back pain with disruption to the left hip. Lastly, he recorded left knee pain.
2. Mr Elmir could not rate his pains in terms of severity. He was able to describe their individual aggravators. He states that he is mostly aware of the neck and shoulder girdle pain when he is trying to get to sleep. Mr Elmir stated that he habitually lies on the left-hand side for as long as he can remember. Now that this side has been injured, he has extreme difficulty getting to sleep and staying asleep. He records only two to three hours' sleep per night. He tries to catch up a little during the day in a recliner.
3. He states that the left lower back and hip pains are aggravated by any form of walking. He tries to walk around the backyard as much as he can.
4. His left knee pain is aggravated by stairs.
5. His left elbow pain is aggravated by carrying objects on the left-hand side. Mr Elmir is left hand dominant.

1. He currently takes the medications Mobic and Nexium. He alternates between Panadeine Forte tablets and Nurofen. He also had a night-time sedative because his sleep is recorded as terrible.
2. He has come under the care of a psychologist and psychiatrist because of his current psychological symptoms. He takes the medication mirtazapine 15-20mg at night-time.
3. He records irritability, poor driving capacity and generally high levels of anxiety.
4. It was observed that he had no knowledge of simple anatomy and movements or exercises. He has relied on massage and passive interventions. He mentioned he was hopeful of going to an exercise facility with insurer-provided financial support. He has resisted any notion of surgery at present.

1. An Arabic interpreter was present for the duration of the examination. His grasp of English was poor.
2. The formal examination was characterized by pain behaviours and general reluctance to move regions due to perceived pain.

1. Mr Elmir has an extremely restricted range of neck movements. There is observable asymmetry. He has very poor left axial rotation and left lateral flexion compared to the right side (one fifth loss). No muscle spasm or guarding was observed. He did not have any symptoms corresponding to non-verifiable radicular complaints.
2. A neurological examination was conducted. He had normal deep tendon reflexes, power and sensation into both arms. There were no signs of muscular atrophy. He did not have radiculopathy.

1. Mr Elmir walks with a very unsteady and asymmetric gait pattern. He states that this is due to his left knee problem. He has a restricted range of motion of the lumbar spine and asymmetrically so. He has loss of right lateral flexion and extension. No muscle spasm or guarding was observed. He did not have any symptoms pertaining to non-verifiable radicular complaints.
2. A neurological examination was conducted. He had normal deep tendon reflexes, power and sensation. Straight leg raising was normal on the right but on the left was mildly reduced due to a combination of pain through the left knee and pain in the lower back, not dural tension signs or radicular complaints. He did not have radiculopathy.

1. Active range of motion of the shoulders was observed, measured by goniometer and tabulated below:

1. In essence, he had loss of range of motion of the left shoulder with a mixed pain pattern. On repeated occasions, he was asked to identify where the painful restriction was located. He indicated that there was pain about the base of the neck and about the left shoulder blade rather than the glenohumeral joint.
2. He had a full range of motion of the left elbow but complained of pain with all movements. He was tender over the lateral epicondyle and also the radioulnar joint to firm palpation.

1. He complains of pain about the left knee but could not be precise. On examination, he appeared to be tender along the medial joint line. A full passive range of motion could be established. Actively, he tended to keep the knee slightly bent which contributed to his abnormal gait pattern. Examination of knee-caps was normal and not tender. Ligament integrity testing was normal, but accompanied by reports of pain.
2. Active range of motion of the knees could not be reliably established. He was able to get on and off the examination couch without assitance.

1. On 14 November 2022, CT of the lumbar spine showed impingement of the bilateral L5 nerve roots and severe facet degeneration at the L3/4 levels.
2. CT of the cervical spine which revealed disc bulges and degenerative changes.
3. MRI of the left knee was performed which revealed tears of the medial meniscus and full thickness chondroplasty in the medial compartment.
4. MRI of the left elbow noted full thickness chondroplasty at the radio humeral compartment and a partial thickness tear at the common extensor tendon origin.
5. MRI of the left shoulder non-acute rotator cuff tear.

1. Mr Elmir was involved in a rear-end multiple car collision on 25 October 2022,
   • he was in the front car in a four-car sequential collision. He reports being jolted by the impact. His car was drivable and later repaired. Police and ambulance not in attendance;
   • at the time of the accident, he states he was in shock but soon became aware of left elbow, left knee and neck pains;
   • at GP first consultation on 7 November 2022 an injury to left knee and elbow only recorded. X-rays ordered;
   • Mr Elmir states that he became more aware of left shoulder and lower back pains over time;
   • Mr Elmir has a history of osteoarthritis of knees receiving a disabled parking certificate on 21 May 2021;
   • Mr Elmir has a history of back pain. GP records "back pains increase" on

17 March 2021; * referred to physiotherapy 9 June 2021 for "ongoing backpain"; * Mr Elmir investigated for back pain with X-ray of lumbar and thoracic spine

on 13 July 2021; * the GP entry on 11 November 2022 records "low back pain with radiculopathy and back pains increasing" with no reference to the motor vehicle accident; * the GP record dated 18 November 2022 expressly addressing the motor vehicle accident writes: "painful left elbow, left knee, lower back pain"; * telehealth consult on 22 November 2022 reports "severe neck pain, after car accident, whiplash injury"; * GP consult on 22 November 2022 reports left shoulder pain due to motor vehicle accident; * Mr Elmir reports habitually sleeping on left side as lifelong pattern, creating pain and stiffness. If this pattern is corrected, it is likely his shoulder pains would resolve; * a permanent impairment of the left shoulder is highly unlikely; * he has had multiple investigations which demonstrate established pathology in all the reported regions. No acute motor vehicle accident injury has been identified for any region; * his pain presentation is closely aligned to his multiple pathologies or degenerative arthritis which may have been flared up by the motor vehicle accident and further unrelated events; * his most prominent and clinically relevant injury is to the neck where he does have a restricted range of motion that appears to influence the shoulder girdle and other pains; * there is considerable internal inconsistency of GP's records and between

Mr Elmir's statements; * given the medical record inconsistencies and the probable minor accident, causation is only accepted for left knee, left elbow and neck. These regions were recorded at the first consultation or reported by Mr Elmir in first fortnight, and * the lumbar spine and shoulder girdle are not accepted as causally related to the motor vehicle accident.

1. There is accident-related support for the following diagnosis:
   • cervical spine-soft tissue injury;
   • left elbow-soft tissue injury, and
   • left knee soft tissue injury.

1. Spinal impairment is calculated from DRE criteria.
2. Peripheral joint impairments are calculated from ROM methodology or DRE.

1. All the calculated impairment is the outcome of the motor vehicle accident.

1. The panel has determined that the claimant has a 5% impairment consequent on the injuries caused by the motor vehicle accident being a soft tissue injury to his cervical spine.